Elda Ramirez

Intervention for medical students: effective infection control.

Needlestick injuries, which lead to the transmission of hepatitis B, hepatitis C, and the AIDS virus, are a potentially serious threat to students during their clinical experiences. Exposure to infectious diseases, blood, and hazardous body fluids is one of the most frequently reported injury events by medical students at a health science center in the southwestern region of the United States. This study was conducted to determine the effectiveness of a customized intervention about infection control for second-year medical students (N = 200). Preparation for the intervention included a needs assessment, which included both qualitative and quantitative research methods that incorporated input from fourth-year medical students, medical staff members, and local hospital infection control specialists. The intervention included a pretest, a lecture, a demonstration of standard precautions and infection control procedure with 2 clinical scenarios, an exercise on proper handwashing, and a posttest. The evaluation of the intervention demonstrated a significant increase in posttest knowledge scores about infection control (from 12.6 +/- 2.1 pretest to 16.5 +/- 1.8 posttest, P < .001). Medical students showed a significant knowledge increase about infection control after participating in the intervention . Thus we recommend that all medical colleges and universities develop and evaluate a similar customized intervention for their medical students.

NURSE PRACTITIONER DELPHI STUDY: COMPETENCIES FOR PRACTICE IN EMERGENCY CARE

INTRODUCTIONnThe Emergency Nurses Association (ENA) convened a Nurse Practitioner (NP) Validation Work Team and conducted a Delphi study to verify and gain consensus on professional and clinical competencies for NPs in emergency care. This document describes entry-level competencies for NPs practicing in emergency care, regardless of setting.nnnMETHODSnA Delphi study was conducted from September 2007 to May 2008 with a national sample of credentialed NPs in emergency care. Using online questionnaires, three rounds were sent to the NPs to reach group consensus. Participants were asked to rate the importance and frequency of performance for each competency as well as list competencies they felt were not addressed in the questionnaires.nnnRESULTSnThe list of competencies was reduced from 111 to 83. In 2008, a Consensus Panel Meeting was convened to validate the Delphi study findings and gain consensus from a multidisciplinary group of stakeholders. Several organizations participated in the meeting (ie, AAEM, AANP, AACN, ACEP, ACNP, ANA, ANCC, BCEN, CCNE, NCSBN, and NONPF). The stakeholders approved a list of 60 entry-level competencies.nnnDISCUSSIONnThere are implications for NPs in the following areas: 1) education, for use in academic settings as a foundation for curricula; 2) practice, emphasizing the unique aspects of practice for the NP in emergency care; and 3) research, including the development of advanced competencies for NPs in emergency care.

A Profile of Nurse Practitioners in Emergency Care Settings

Purpose To determine characteristics of nurse practitioners (NPs) who provide emergency care. Data Sources Descriptive cross‐sectional study of a convenience sample of 113 NPs in emergency care obtained from the online Resource Directory of Nurse Practitioners in Emergency Care. Conclusions The majority of NPs in emergency care worked in facilities that were located in urban/suburban areas, were responsible for providing care in both the main emergency department and fast track area, held a Master of Science degree in nursing, obtained their education as a family nurse practitioner, and were certified as an NP by a national certifying agency. They were experienced registered nurses before becoming an NP but were relatively new to the NP role. Implications The results of this study provide information about characteristics of NPs who provide emergency care.

Developing nurse practitioner treatment competencies in emergency care settings

Nurse practitioners (NPs) providing care in the emergency department do not have recognized treatment competencies. The purpose of the study was to establish a definition of the NPs in emergency care settings, by examining the treatment competencies. The overall goals of this research project were to perform psychometric testing on the Nurse Practitioner Treatment Competency Instrument (NPTCI) and identify competencies relevant to the NP in the emergency department. The research questions for this study were as follows: What were the internal consistency reliability estimates for the NPTCI as measured by Cronbachs alpha reliability coefficients? What was the construct structure of the NPTCI as evidenced by the factor loading extracted from an orthogonal, rotated, exploratory factor analysis? What items in the NPTCI were relevant to the emergency nurse practitioner? The task analysis branch of the Kane model, “Model-Based Practice Analysis and Test Specifications,” is the segment this study used to establish the framework for conceptualization and identification of treatment competencies for NPs in emergency care. A descriptive postal survey was conducted using a national sample. The data for this study was collected using the NPTCI that examines demographic information related to NP practice and the relevance of specific activities/tasks that are identified by established family and acute care competencies. The instrument was sent to family, acute care, and emergency NPs. The total estimated sample size was 1,778; of the 582 who responded to the questionnaire, 42 were emergency NPs. The NPTCI was found to be reliable and valid using factor analysis and Cronbachs alpha. Fifteen competencies out of 89 were not relevant to the emergency NP.

The emergency nurse practitioner: An educational model

T he e m e r g e n c y nurse pract i t ioner (ENP) has a vital role in del ivering heal th care in an emergency depar tmen t . 1 Unti l recently, a nu r se who w a n t e d to b e c o m e a nu r se pract i t ioner (NP) and specialize in e m e r g e n c y care had to a t tend an adult NP, family NP, or pediatr ic NP program. Because these NP programs are pr imary care based, g radua tes are well versed in pr inciples of heal th promotion, d isease prevent ion, and e p i s o d i c care of n o n u r g e n t condi ~ tions. For the NP in te res ted in prac t ic ing in the emergency depar tment , however, exper ience in the a s s e s s m e n t and m a n a g e m e n t of u rgen t and emergen t condi t ions is essential . Recogniz ing that ENPs n e e d knowledge, skills, and exper ience u n i q u e to the e m e r g e n c y depar t ~ ment, the authors developed and imp lemen ted at The Univers i ty of Texas Health Science Center at Houston, School of Nursing, the only ENP program currently in the Uni ted States tha t focuses exclusively on the provision of emergency care. The program is descr ibed in this article to serve as a framework for other educators in te res ted in developing an ENP program.

Procedures Taught in Family Nurse Practitioner Programs in the United States

Purpose To determine the most frequently taught procedures and how important it is to teach these procedures in Family Nurse Practitioner (FNP) programs in the United States according to FNP program directors. Data Sources Each of the 178 directors of FNP programs in the United States was mailed a survey to complete anonymously. The survey, designed for this study, listed 78 procedures. Directors were asked to indicate whether or not the procedure is taught in their FNP program and how important they think itis that FNP programs in the United States should teach that procedure. A total of 114 (64%) responded. Conclusions A total of 10 of the 78 procedures were taught in 50% or more of the FNP programs. These procedures were; obtaining Papanicolau smears, testing visual acuity, audiometry, tym‐panometry, splinting of extremities, interpret‐ing 12‐Lead electrocardiograms, interpreting blood gases, local infiltration of anesthetics, single layer wound closure, and fluorescein staining of the eyes. The directors believed that six of these were very important to teach in FNP programs. Implications for Practice The findings of this study can be used to plan course content related to procedures in new FNPprograms or to revise course content in existing programs. The study results are helpful to individuals who develop continuing education courses to target skills that NPs may find valuable or may need for their current employment setting but were not taught in their educational programs.

Standards of Practice for Emergency Nurse Practitioners.

ENPs are specialized licensed practitioners, who possess the necessary clinical competencies to provide optimal care to patients in ambulatory, urgent, and emergent care settings. ENP specialization builds upon NP entryinto-practice knowledge and skills and requires a minimum of a master’s level preparation or specialized preparation at the post-master’s or doctoral level. ENPs demonstrate competencies by applying standardized care guidelines in their clinical practice. Other ways of continuing competencies include participation in maintaining continuing education, quality improvement processes and peer reviewsincluding the systematic periodic review of records and treatment planswhile maintaining specialty and population-focused certification in compliance with current laws and regulations.

Assessment of acute hand injuries: part I.

More than 140,000 hand injuries occur yearly, and an estimated 5 days of loss of work per patient occurs (Bureau of Labor Statistics, 2012). Advanced practice registered nurses (APRNs) are responsible for managing many of these injuries in primary and emergency care settings. Hand injuries are responsible for approximately 10% of all emergency department visits annually (P. Shayne, S.H. Plantz, & F. Talavera, 2012). This article reviews approaches to the assessment of the patient with a hand injury and establishes a process for basic identification of the hand structures and function. Approaches to history taking and specific evaluations for the hand will be discussed and examples of the assessments will be provided. Diagnostic approaches to support physical findings will be discussed, and methods of radiologic assessment will support the audience in making appropriate diagnosis in relation to hand injuries. This is Part I of a three-part series that will validate the approaches to hand assessment for adults and children and identify specific injuries and their management for the APRN.

Management of Hand Injuries: Part II.

Hand injuries are a frequent emergency department occurrence and account for most upper extremity injuries. Proper assessment and management of hand injuries can reduce morbidity and prevent long-term disability. “Assessment of Acute Hand Injuries” Part I was discussed in the Advanced Emergency Nursing Journal (E. G. Ramirez and K. S. Hoyt, 2014). Part II herein discusses the epidemiology, radiographs, and the management of hand lacerations, fingertip injuries, and fractures. Part III will discuss the management of tendon, ligamentous, neurovascular, and other special hand injuries along with the management of selected chronic hand conditions.

Introduction to reading and clearing cervical spines for advanced practice nurses, Part I.

This article is Part I of a two-part series and will focus on the key concepts of radiographic interpretation, functional cervical anatomy, and the interpretation and clearance of cervical spines in emergency care. In the subsequent issue, Part II will cover the additional epidemiology of cervical-spine injuries, specific injuries, case studies, and advanced diagnostic imaging.